Meta-Analysis Shows IVUS-Guided DES Implantation Improves Outcomes

February 11, 2014—Jae-Sik Jang, MD, et al published findings from a systematic review and meta-analysis of randomized trials and observational studies of intravascular ultrasound (IVUS)-guided versus angiography-guided implantation of drug-eluting stents (DES). The study is available online ahead of print in Journal of the American College of Cardiology: Cardiovascular Interventions.

According to the investigators, the background of the study is that in the era of bare-metal stents, studies suggested that there were clinical benefits to IVUS guidance, but it is still controversial whether percutaneous coronary intervention (PCI) with DES guided by IVUS leads to better clinical outcomes.

The investigators searched for and identified relevant studies published through March 31, 2013, in electronic databases. Summary estimates were obtained using a random-effects model. From 138 initial citations, the study included three randomized trials and 12 observational studies with 24,849 patients (11,793 IVUS-guided and 13,056 angiography-guided cases).

The investigators reported that comparison of IVUS- versus angiography-guided PCI disclosed odds ratios (ORs) for major adverse cardiac events of 0.79 (95% confidence interval [CI], 0.69 to 0.91; P = .001). IVUS-guided PCI was also associated with significantly lower rates of all-cause mortality (OR, 0.64; 95% CI, 0.51 to 0.81; P < .001), myocardial infarction (OR, 0.57; 95% CI, 0.42 to 0.78; P < .001), target vessel revascularization (OR, 0.81; 95% CI, 0.68 to 0.95; P = .01), and stent thrombosis (OR, 0.59; 95% CI, 0.42 to 0.82; P = .002). A meta-analysis of propensity-matched studies demonstrated similar results in terms of clinical outcomes, but not repeat revascularization.

The investigators concluded that IVUS-guided DES implantation is associated with significantly lower rates of adverse clinical events compared with angiography guidance. Further study is needed to clarify which subgroups of subjects with IVUS guidance will have greater benefit, advised the investigators in Journal of the American College of Cardiology: Cardiovascular Interventions.